Breast Health (4 questions) Flashcards
Normal vs abnormal nipple discharge
- Clear or milky usually non cancer
- Bloody or spontaneous discharge is cause for concern
What are fibroadenomas and when would they be a concern?
- Most common benign tumor
- Estrogen stimulated, may grow over time in cases such as pregnancy
- Usually painless
- It is only removed if grows or causes pain
What are intraductal papillomas and are they removed or not?
- Growths in the milk ducts
- Cause clear or bloody discharge
- Removed for full diagnosis
What are calcifications and are they removed/investigated or not?
- Characterized as macro or micro
- Caused by age, inflammation and trauma
- Macrocalcifications do not need investigation
- Microcalcifications in certain shapes and patterns require imaging and biopsy
What are fibrocystic changes and do they warrant interventions?
- Occur in the glandular (lobules & ducts) and stromal tissues
- Breast may feel lumpier, thicker, swollen, sore or tender
- May warrant biopsy
Who is prone to fibrocystic changes?
Affect ½ of all woman between 20 and 50 years of age
What are breast cysts and should they be removed?
- Fluid filled sacs, movable lumps, resolve after her period
- Evaluated by ultrasound
- If painful, may be drained in the office
- Remove cyst if fluid is bloody
What makes a microcalcification worrisome?
four to five clustered - potential for cancer
Characteristics of breast cancer
- Occur in one breast
- Are singular lumps
- Very firm to hard
- Feels uneven with irregular borders
- Less likely to cause pain
Risk factors for breast cancer: age
55 and older
Risk factors for breast cancer: gender
100X more common in women than men
2 out of 3 women with invasive breast cancer
Breast cancer risk factors: genetic factors
5-10% linked to inherited mutations
ACR cancer screening guidelines
- Annual screening mammogram
- Age 40 for general population
- Age 25-30 (or) 10 years prior to age of affected 1st degree relative’s diagnosis of premenopausal breast cancer (OR) if lifetime risk ≥20% based on FH
- Age 25-30 for BRCA carriers
- Fails to detect 20% of cancer that become palpable within 1 year
With what kind of breast tissue is cancer easier to detect with a mammo?
fattier w/fewer glands (happens with age)
difficult in dense breasts
What is a 3D mammogram
Tomosynthesis:
- Views the breast in thin “slices” rather than as a whole
- Improves detection of lesions and reduces false positives
- Proven to decrease call-back rates by 30%+
- Quickly becoming new standard of care for screening
What test is most helpful in determining if a palpable mass is solid or fluid filled?
U/S
Used as a backup tool in evaluating dense breast tissue
When would an MRI be used to investigate a breast lump?
High Risk Screening Tool
- Usually ordered by a Specialist
- BRCA 1/2 mutation carriers
- Strong family history
- Lifetime risk ≥25% per risk assessment model
What are findings that would increase risk for breast cancer?
- Lobular Intraepithelial Neoplasia (LIN)
- Lobular Carcinoma In Situ (LCIS)
- Atypical Ductal Hyperplasia (ADH)
How is LCIS usually found?
- Lacks clinical or mammographic signs
- Incidental microscopic finding in tissue biopsied for another reason
What is the relationship of LCIS to invasive breast cancer?
- 7-10-fold increased risk of invasive breast cancer, or 1%/year, or 25% lifetime
- Equal risk for both breasts
- Most are actually invasive ductal
- Considered a risk factor, but not a precursor lesion
- Consider chemoprevention in these patients
What fraction of breast tumors are estrogen receptor positive?
~2/3
How do SERMs work and what are examples of SERMs?
Selective Estrogen Receptor Modulators - inhibit ERs
Tamoxifen, Raloxifene
By how much do SERMs decrease risk of BC?
50%
HOw do aromatase inhibitors work and what are examples?
inhibit estrogen
Exemestane
What limits the use of aromatase inhibitors?
- only for post menopausal women
- bad side effects:
- common: Vasomotor, myalgias, arthralgias, vaginal dryness
- Rare: Osteoporosis
By what percent do aromatase inhibitors reduce the risk of BC?
90%
Side effects of SERMs
- Common: Vasomotor, leg cramps, vaginal discharge, menstrual irregularities
- Rare: DVT/PE, uterine cancer, cataracts
Why would SERMS or AIs be Rxed?
chemoprevention
e.g., ADH, LCIS, risk factors >25
What is BI-RADS?
mammography assessment categories - standard numerical codes assigned by a radiologist
What are the BI-RADS assessment categories?
· 0: Inconclusive
· 1: Negative
· 2: Benign finding(s)
· 3: Probably benign
· 4: Suspicious abnormality
· 5: Highly suggestive of malignancy
· 6: Known biopsy – proven malignancy
